DIMENSIONS Spring 2004

Home Safety: Living at Home With AD

by Joanne Webb

Anticipating and assessing potentially unsafe situations can be challenging for family members caring for a relative with Alzheimer’s disease at home. Finding a balance between safety and independence is not always easy, and even situations that are clearly unsafe may be difficult to change. Some decisions, such as stopping driving or taking over medication management, often involve a period of emotional adjustment for the person with dementia and the family. For the person with dementia, there may be feelings of resentment and loss, while family members often feel guilty or unhappy about having to restrict their loved one’s activities. Moreover, identifying and resolving home safety problems is not a straightforward task involving a single assessment and implementation, it needs to be an ongoing process, and it intensifies as cognitive problems become more severe.

There are three general principles that can help increase safety and reduce stress in the daily home life of both the person with dementia and his or her caregiver:

1. It is better to take precautions to prevent an accident or crisis than to deal with the results afterwards (for example, a broken hip, psychological trauma, nursing home placement).
2. It is easier and more effective to change the environment than to change the behavior of the person with dementia (for example, lock up dangerous objects or remove them from the home, reduce clutter, fix the broken step, rather than constantly monitoring your relative’s every move).
3. When you create a safe home, you minimize the danger and maximize independence of the person with dementia, and you will both benefit from a happier, calmer household, reduced stress and less worry.

In evaluating home safety it is also vital to assess the degree of supervision that the person with dementia requires. Many caregivers wonder whether (and for how long) it is safe to leave their relative at home alone. If you aren’t sure, ask yourself the following questions:

1. Does the person become confused or unpredictable under stress? Do they recognize a dangerous situation such as fire?
2. Can they use a phone in an emergency and do they know how to get help?
3. Are they content within the home or do they wander and become disoriented?
4. Does the person show signs of agitation, fear, or depression when left home alone?
5. Do they still attempt what are now potentially unsafe activities such as woodworking, cooking, or driving when unsupervised?

Family members and individuals with dementia must continue to adapt the home as dementia symptoms progress. A home safety check-list can be a helpful organization tool and a way to look at your home and familiar belongings with an objective view towards potential accidents. It can also be a time saver in the process of continual readjustment. Taking the time to walk from room to room, checking off items on a periodic basis, and making needed changes as soon as possible will go a long way to prevent home accidents.

Some of the changes you’ll need to make may require special equipment such as bathroom grab bars. These items can be found in hardware, variety and medical supply stores. Many communities have programs that provide home repairs and modifications at no charge or reduced rates to elderly and disabled residents. Your local Senior Information and Referral service will have information about such programs and may have referrals for small job contractors who can install handrails and other fixtures in the home at a reasonable cost. The inconvenience of making these changes and the cost of the work, even at full price, will be more than offset by your peace of mind and your relative’s increased safety. If you are caring for a person with dementia, the following resource is highly recommended to help ensure a safe environment:

Home Safety Room By Room, NIH Publication No. 02-5179, can be obtained from the Alzheimer’s Disease Education and Referral Center (ADEAR) 1-800-438-4380 or online at www.alzheimers.org/pubs/homesafety.htm.